Is Express Scripts your Pharmacy Benefit Manager?

If so, apparently they have not reached a contractual agreement with Walgreen's, so you no longer can fill prescriptions (including refills) at Walgreen's. They're probably going to keep negotiating and this may change, but as of today, you cannot fill a prescription at Walgreen's. Jennifer

Monday Musings

A bit of a struggle this morning. I'm tired. But work comes first, and so here's the news:

As I told you on Friday, the US has filed its brief in the health reform case. As you know, the main part of the case challenges the requirement that people buy insurance. One of the individual plaintiffs is a woman who said it was her right to self-insure rather than buy insurance. The US has been saying all along that folks like these end up shifting the cost to the public. While the case has been pending, the woman racked up a lot of bills -- including medical bills -- and filed for bankruptcy protection. Which served to prove the point that the US has been making all along. It is NOT okay for people to shift the cost of health care to the taxpayers, and the best way to make sure that doesn't happen is to require them to buy insurance. This was one of the most convincing parts of the government's brief. Meanwhile, over 100 Republicans and economists filed an amicus (friend of the court) brief arguing that the Supreme Court should strike down the entire law if they find the individual mandate to be unconstitutional.

The health care sector continues to add jobs.

What's it like to be hearing impaired? Read and maybe you'll understand.

A run of thefts in pharmacies, looking for narcotics.

Hope for people with cystic fibrosis.

A small study shows that deep brain stimulation may help people with bipolar disorder.

Robotic devices help paralyzed people.

Poor sleep worsens health in kids with type 1 diabetes.

Should young people be getting obesity surgery? Is caffeine a weight loss aid?

A virtual cadaver for medical students to learn on.

The answer to last week's guess the diagnosis quiz from the NY Times. And once again, a reminder that we should not rest until we find answers to our medical problems.

That's it for this morning. Have a great day. Jennifer

Health Reform Brief

The US Department of Justice filed its brief on the individual mandate in the Supreme Court today. In case you are dying to read all 60 pages, here it is. If there's anything remarkable or unanticipated in it, I'll let you know -- after I've read it. Jennifer

P.S. -- Well, I've read it and it's really remarkably good. It's straightforward, clear, concise, and convincing. There were no surprises, at least in my view. If you're curious, give it a quick read. It's not overly technical -- just skip over the citations. I know I'm convinced, but that's no surprise, I trust. J

Finally Friday Edition

No long week-end this week. Oh, well. But there's still the news:

Most hospital errors go unreported. That's fairly shocking to me considering the number of adverse events that ARE reported. You really should consider taking steps if you are going into the hospital. I just read a new book call the Patient's Checklist. It helps you to remember all the things you need to know to make sure you get in and out of the hospital no worse off than when you began.

How health reform helps to control health care costs, by HHS Secretary Kathleen Sebelius.

The first round of briefs is due today in the health reform Supreme Court case. According to some experts, it will be critical for the government to explain not only why the individual mandate is within Congress's powers, but what the limit on those powers is.

The feds -- both Congress and the White House -- cut funds for heating assistance right at the start of winter, just before they left town for their holiday break. This is an outrage. It's not even a lot of money, as things go. And if you think it's not a health issue, wait until people start getting sick and have no heat.

Collaborative care -- employers, insurers, providers all working together -- may be a more efficient, effective health care delivery system.

States are asking for more funding for the Pre-existing Condition Insurance Plan, which covers people with pre-existing conditions until 2014, when insurers won't be able to exclude people with pre-existing conditions any more.

Arizona passed a law allowing the use of medical marijuana. The (pretty nutty) Governor sued to try to stop it from taking effect. A court threw out her lawsuit.

A Massachusetts court has found that the State cannot exclude legal immigrants from a state health plan. The court based its decision on the State Constitution, so how much this will affect other states is hard to say. But this brings Massachusetts another step closer to truly universal health care.

Shame in filling a prescription? When faced with alleged drug shortages of controlled substances or ADHD drugs, patients have to run in circles to get their meds, and some feel shame for needing them.

Is being fat a destiny? Recent articles, summarized by USA Today, discuss. I particularly recommend the NY Times article from last Sunday's NY Times Magazine.

Some employers are banning smokers from the workplace. Not just smoking, but smokers!

A hepatitis C vaccine is hopeful, but years away. A potential herpes vaccine falls short.

A recent dust up over a study reporting a way to make bird flu airborne raises the question -- how close are terrorists to being able to spread a communicable disease?

Can yoga wreck your body? Surprisingly, yes.

And that's today's news. Have a great day! Jennifer

Thursday Themes

It's Thursday already and that's a good thing. Here's the news:

Private insurers are profiting from increase roles in Medicare and Medicaid. Despite the poor economy, health insurance is a very profitable business. This is so despite the fact that fewer employers are offering coverage, and those who do are charging employees more for it.

Here's another one of those NY Times puzzles -- guess the diagnosis. I'm totally hooked on these. In this one, one of the doctors is an old friend and colleague of my brother's (Jeff Olin), which really makes me curious. Can't wait for the answer!

HIV/AIDS is increasing within the Navajo Nation, at a time when they are decreasing in the general population.

Food allergies are an increasing problem, and vigilance is required. Not only do you have to be careful about what you eat, but you also have to prepare for slip-ups.

A new study shows that even a small gap in insurance compromises the health of a diabetic. I'm certain the same can be said of other illnesses, as well.

HHS rejected Kansas and Oklahoma's request for a waiver of the medical loss ratio requirement. This means insurers in those states will have to spend 80 or 85 percent of premium dollars on health care. Good.

A whistleblower suit accuses a nationwide hospice company of cycling patients through nursing homes and hospice to maximize profit.

A new study says that, although heart attack victims in the US will spend only 2-3 days in the hospital after the attack, they are more likely than patients in other countries to be readmitted to the hospital within the next month.

Drug shortages are an increasing problem due to hoarding and price gouging.

Will electronic monitors of caloric intake help people lose weight?

Due to concerns about resistance to antibiotics, US officials are further restricting the use of antibiotics in livestock.

The FDA has ordered a study of surgical mesh used to treat urinary incontinence in women due to many reports of injury.

And there you go -- a lot of news for a Thursday. Have a great day! Jennifer

Hump Day Headlines

Good morning! Let's get right to the news:

Think your medical records are safe, private? Read this harrowing tale.

Under health reform, starting now, there's a $1 annual fee on all private insurance to fund comparative effectiveness research -- research that shows whether one treatment really works better than another. The GOP are complaining. They think this will lead to rationing. However, as we know, private insurers already "ration" to the extent of paying only for things they believe will work.

The American College of Physicians is taking the position that doctors should consider cost effectiveness when ordering services.

Adult day care centers keep seniors out of nursing homes -- but struggle for funding.

The Hartford has come up with a new life insurance product, a rider that allows the insured to draw down on their policy to cover the cost of chronic illness -- an alternative to long-term care insurance.

HHS has chosen 73 "innovation advisors" who will work with the Centers for Medicare and Medicaid services to foster innovation in medicine.

Research shows chiropractic and exercise are better than pain meds for neck pain. I've also read over the years that chiropractic can cause strokes. I don't know for sure, but I'd be careful and make sure you're seeing a reputable chiropractor.

And that's it for today -- a light news day. Have a great one! Jennifer

Happy 2012

And here I am in the office at 6 am so I can bring you this blog every day. One of my New Year's resolutions is to stop coming to the office at 6 am. That may mean a change to this blog -- maybe I won't read 8 newspapers per day; 4 or 5 would probably do. Anyway, we'll see how it goes. For today, it's the norm -- here's the news.

Expect 2012 to be a year in which we talk alot about Medicare. With the boomers joining the ranks, we can't afford to sustain what we have, some argue. But others says we must hold the line firm.

The Government Accountability Office found that the Department of Justice is not doing a good job policing standardized testing companies to ensure that disabled test-takers have the accommodations they need.

Some states are working on getting their Exchange up and running in time to sell insurance effective January 2014. But in states that are refusing to comply with health reform, there should be a federal fall-back Exchange -- but will it be ready?

The Pre-existing Condition Insurance Plan continues to be a great option for people who've gone without insurance for 6 months. It's grown to about 6000 in California alone.

10 provisions of health reform take effect in 2012. Not the really critical ones, but they may help affordability and care coordination.

California Blue Shield settled a lawsuit that requires them to pay $2 million for dropping people when they found out they were sick. A similar suit against Anthem still is pending.

When nurses catch compassion fatigue, watch out. If you've ever been in the hospital, you know that the key is a pleasant, caring nurse. But could you keep that up every day?

Smokers are paying more for health insurance. An incentive to stop smoking? We hope so.

There's a shortage of ADHD drugs. Hundreds of people are complaining to the FDA every day. Ritalin and Adderall are affected. The Drug Enforcement Agency set manufacturing quotas on these drugs to try to avoid street use, but the result is that kids don't have their meds. Along the same lines, although not mentioned in the news, Salix Phamaceuticals has stopped manufacturing brand name Colazal. They have a new, equivalent med coming out shortly that they thought would be FDA approved by now. But the FDA has held up the new drug approval, and this is leaving Crohn's and colitis patients without brand name meds.

Insured Americans share healthier habits than the uninsured. I suspect that's largely because insured Americans as a general rule are employed and/or financially sound.

Two new books are good for patients. Confessions of a Surgeon tells most of us who've been through surgery what we already know -- surgeons just do surgery, and nothing else. But the Patient's Checklist sounds really interesting -- a way to make sure you are getting appropriate and safe care. I was contacted last week to see if I'd read an advance copy and review it for you, so I'm waiting for it to arrive so I can get into it. And here's an interesting piece by a surgeon that makes me never want to go near an OR again.

New thoughts on treating anorexia nervosa.

Connecticut cans Medicaid managed care in favor of the old fee-for-service model, as other states experiment with managed care. Those states ought to look at how much money we lost to the private insurers running managed care.

Hundreds of patients linger in New York City hospitals because they have nowhere to go. They are illegal immigrants or don't have insurance or any type of support system. Of course, hospital care is the most expensive option, but Medicaid won't cover their stay in a nursing home, so hospital care is their only option.

And that's it for today. Have a great start to 2012! Jennifer